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20 1 Commissioner Bedford said on March 27t" the News & Observer wrote an article 2 reporting that the State Auditor Beth Wood had again found that there are hundreds of millions 3 of dollars being held by these MCOs, in excess of the recommended 2% fund balance. 4 Commissioner Bedford said today Cl responded with actual numbers of the $4 million 5 community outreach done by Cl. She said it was expressed that Orange County is the largest 6 county in this region, but the rates are set by actuaries and are based on a complex formula. 7 She said, even as a CPA, these documents can be hard to follow. She said she has provided 8 the Board with CI's list of eligible members, starting with Mecklenburg County at over 1 million. 9 She said Orange County falls in the middle, but this is irrelevant, as the County will be funded 10 based on the formula on a per person basis. 11 Commissioner Bedford referred to the issue of funding Club Nova, who came to the 12 Board with the news of this $500,000 funding promise made by Cl, but that this promise was 13 contingent upon Club Nova raising 80% of it $4.5 million goal by year's end. She said this goal 14 is lofty, if not unattainable. 15 Commissioner Bedford said there is language that states, "LME/MCOs shall be 16 prohibited from offering, and counties will be prohibited from receiving any financial or material 17 inducement to change or maintain current affiliation," and so these funds to Club Nova should 18 not be a factor in the Board's decision. 19 Commissioner Bedford said this goes into effect in 2021, and the County is committed 20 for 4 years thereafter. She said sending the letter is no guarantee of regrouping, but is an 21 opportunity to provide input. 22 Commissioner Bedford said the email from Cl also indicated that it is the oldest and 23 most mature MCO, and is thus reason to stay with Cl, but she finds this illogical. 24 Commissioner Marcoplos clarified that sending a letter to NCACC is an opportunity for 25 the Board to express its will, and the DHHS will make the final decision. He asked if the odds of 26 success are known. 27 Commissioner Bedford said in part 1 of Medicaid, Orange County is grouped differently, 28 but really she has no idea why. She suggested copying the DHHS secretary. 29 Commissioner Greene said she did not support this last time, but she has now talked 30 with Commissioner Bedford and feels far more informed this evening. 31 Chair Rich said she and Commissioner Bedford spoke several times, and she also 32 spoke with Club Nova, as well as Representative Verla Insko and Representative Graig Meyer. 33 34 PUBLIC COMMENT: 35 Ric Bruton, Cardinal Innovations Healthcare, said he regrets Commissioner Bedford was 36 not present at the last meeting. He said he would love to speak further with her about the 37 financial information. He said Medicaid reform is coming in November, and those with mild to 38 moderate mental health and substance abuse disorders will be transition to commercial 39 managed care, which will be a big change. He said there will be another change in 2021, and 40 he does not recommend that the Board add yet another layer of change. He said there is a lot 41 of potential for disruption, and he feels the community served by CI would not be in favor of the 42 Board passing this motion. 43 Commissioner Dorosin asked if these groupings are changed, would it be in 2021. 44 Commissioner Bedford said implementation is for 2021. She said Medicaid part 1 will 45 be implemented in November 2019. 46 Commissioner Dorosin said he has heard a great deal of dissatisfaction from the 47 community regarding Cl, and while he was the BOCC representative, he was very disappointed 48 by how the County was treated. He said he is grateful that the Board of County Commissioners 49 is willing to take this up, and he supports this change, as it has been an unsatisfactory 50 relationship.